[A multidisciplinary approach to the management of cerebral vascular malformations]

Cerebral vascular malformations (CVM) are a heterogeneous group of lesions. One way of classifying them is according to histological criteria, clinical features, imaging findings, electroencephalography and distinctive pathology.

To report the results obtained in 16 patients clinically diagnosed as having CVM and operated on in the Centro Internacional de Restauración Neurológica (La Habana, Cuba) between March 1995 and October 1998. We also consider the usefulness of diagnostic tools for neurosurgical management and anatomo-pathological diagnosis.

We review the clinical findings, images, electroencephalograms and diagnostic histology of 16 patients. The gender distribution was 10 men and 6 women who were aged between 9 and 48 years. Stereotaxic resection guided by CAT and angiography was done in all cases.

The predominant symptoms were headache and generalized tonic-clonic convulsions. CAT and angiography were helpful in determining the clinical diagnosis and location. The most frequent electroencephalographic finding was focal slowing associated with inactive epileptiform disorders. Histological study showed that there were 3 cases of arteriovenous malformations (AVM), one angioma cavernosa and one mixed vascular malformation (AVM plus angioma cavernosa). The malformation was not resected (it was treated with a clip) in the remaining case.

Our results show the importance of structural imaging studies and their relationship to functional studies in the presumptive diagnosis of CVM corroborated by post-operative histological diagnosis.